Tofisopam

Tofisopam goes by the label benzodiazepine, yet its structure departs from diazepam and its relatives. The ring system is the 2,3 type, not the 1,4 arrangement found in the older drugs. Its producers say anxiety eases with less sleepiness than the familiar members of the group would cause. That is their assertion; UK regulators have not confirmed it. In parts of central and eastern Europe it has been in clinical use for years; Britain has never authorised it.

A 50 mg tablet is offered and nothing else. It is imported, so its carton and leaflet were not written with British patients in mind. On receiving it, check the name, strength and expiry date on the strip, and keep the blisters dry and where children cannot reach them. A pharmacist can confirm the strip details if anything is unclear.

The electronic medicines compendium has no entry for tofisopam. That leaves nothing approved to quote, whether product information, licensed indication or recognised dose, and so this page offers none. Dose advice seen elsewhere reflects other countries’ rules and may be unsuitable here. The usual British protections for a licensed medicine, such as authorised lists of side effects, interactions and driving restrictions, are absent as well, which is why those subjects are not covered with false confidence. Ask the prescriber about effects on driving and interactions with alcohol or sedatives before taking tofisopam.

A doctor who prescribes it accepts responsibility for judging whether an unlicensed product is suitable. Useful topics are earlier dependence or heavy drinking, kidney or liver disease, pregnancy plans, breastfeeding, driving and every other medicine being taken, sleeping tablets, opioid painkillers and sedatives above all. Ask also what the next step would be if it fails to help. Never drop an existing anxiety treatment overnight just to make room for another.

Guideline CG113 from NICE lays out a series of steps for generalised anxiety disorder. Education and active monitoring begin the process; guided self-help follows; cognitive behavioural therapy or applied relaxation comes next. Step 3 offers either high-intensity psychological therapy or medication, and where drugs are chosen an SSRI is the starting point, with sertraline considered first. Benzodiazepines are limited to brief use in a crisis. Antipsychotics are not advised in primary care. People in England can contact NHS Talking Therapies directly, without a GP referral.

Constant worry, panic attacks or a heavy low mood merit a full assessment, which a GP can arrange. Thoughts of harming yourself are an emergency: ring 999 or 111, or attend A&E. Any problem that might stem from an imported medicine can be notified to the MHRA via the Yellow Card scheme.

Over the years, benzodiazepines have become known for sedation, slower reactions and, with prolonged use, dependence, and this explains the NICE preference for short courses. Alcohol amplifies the sedation, and opioid painkillers make the mixture dangerous. In the absence of UK information it would be wrong to assume tofisopam escapes these effects. Unusual drowsiness, confusion or unsteadiness means stopping and getting medical advice. Whether to use it at all rests with you and your prescriber, ideally after the earlier NICE steps have been talked through.